Parity nears reality

In a major win for psychology and mental health advocates, Congress has embraced mental health parity. Now it's negotiating ways to pay for it.

By
Amy Novotney

Monitor Staff

2008, Vol 39, No. 8

Print version: page 14

After wrangling over the issue for more than a decade, in June, negotiators for the U.S. Senate and House agreed to legislation that will end insurance discrimination against mental health and substance use disorders. The measure requires employers that offer mental health services coverage to provide these benefits at the same level as they do for other medical conditions.

At Monitor press time, Congress was still deliberating over how to fund the measure. But if enacted, the legislation would extend to all aspects of an insurance plan's coverage, including day and visit limits, dollar limits, co-insurance, co-payments, deductibles and out-of-pocket maximums.

In addition, if a plan offers medical treatment out-of-network, it must do so for mental health as well.

That's great news for the estimated 113 million Americans enrolled in group health plans covered by the federal parity law, says APA's Executive Director for Professional Practice Katherine C. Nordal, PhD, because the bill's passage will remove one of the biggest barriers to accessing mental health treatment: affordability.

"The benefit to the country, long-term, will be that people will get treated earlier, and because they get treatment earlier, they're going to have better mental health outcomes," Nordal says.

Improved psychological health, she adds, will reduce the population's need for physical medical care and help lower overall health-care costs.

It's also cost-effective for businesses. A May National Institutes of Health study shows that major mental disorders cost the nation at least $193 billion annually in lost earnings, mostly due to reduced productivity and absenteeism.

The APA Practice Organization has been involved in educating legislators on the importance of equal coverage for physical and mental health-care services throughout parity's journey through Congress. The group also helped draft language for the bill's pre-emption standard, which will ensure that stronger state parity and other consumer laws remain in place. Currently, 43 states have some sort of mental health parity law in place. This legislation would set one broad standard for the nation.

Federal mental health parity has been on Congress's agenda for nearly 15 years. Sen. Pete Domenici (R-N.M.) introduced the first federal parity bill in 1992, a move that led Congress to enact parity for annual and lifetime dollar limits in 1996 through the Mental Health Parity Act. Insurers evade this law by limiting outpatient visits or hospital days, and by charging higher co-payments for mental health services. Then in 2001, 8.5 million federal employees, retirees and their dependents received mental health insurance parity through the Federal Employees Health Benefits program, the largest employer-sponsored health insurance program in the nation.

The current compromise contains elements from legislative measures passed in the Senate in September of 2007 and in the House in March of this year. In July, Sen. Max Baucus (D-Mont.) added the bill to a large energy and tax bill, but that was blocked from consideration on the Senate floor.

The Monitor will present a full report on the legislation as soon as Congress takes final action on the measure.